Danial Azmy Habib Steven, Gunawardena Methsala
Internal Medicine, Hampshire Hospitals NHS Foundation Trust, Basingstoke, GBR.
Rheumatology, Hampshire Hospitals NHS Foundation Trust, Basingstoke, GBR.
Cureus. 2024 May 5;16(5):e59686. doi: 10.7759/cureus.59686. eCollection 2024 May.
Giant-cell arteritis (GCA) is a type of vasculitis characterised by the presence of granulomas. It is the predominant form of systemic vasculitis in adults and primarily affects the larger arteries in individuals aged ≥ 50 years. GCA affects the major arteries, such as the aorta and its branches, particularly the outer branches of the external carotid artery. Signs and symptoms can be categorised into cranial, extracranial, and systemic manifestations. Patients with headaches, jaw claudication, and vision disturbances usually have extracranial branches of the external carotid artery. Aside from being the prevailing manifestation of GCA, our primary concern regarding this variant is the potential for irreversible vision loss if not properly identified and addressed. Conversely, the GCA can also affect other major blood vessels such as the aorta. Here, we present the case of a 70-year-old Caucasian female patient with cranial GCA who had experienced a temporal headache three years prior. The patient was successfully treated with prednisolone, which was gradually reduced to a very low level with the assistance of methotrexate. Recently, the patient presented with a dry cough that lasted for two months and elevated inflammatory markers. After thorough research, it was determined that there was no evidence of infection, including atypical infections, and that no abnormalities were found in the lungs. Ultimately, via an 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) scan, the patient was diagnosed with large vessel giant cell arteritis (LV-GCA). This impacted the aorta, carotid arteries, and subclavian arteries. The patient experienced notable improvement in her cough and a reduction in inflammatory markers after receiving a high dosage of oral prednisolone. This case exemplifies the unusual manifestation of LV-GCA and verifies that recurring symptoms may differ from the original presentation. While dry cough is not commonly listed as a symptom of LV-GCA, it can be present as a manifestation or the sole presentation in certain patients, particularly when inflammatory markers are consistently high and there is no pulmonary disease.
巨细胞动脉炎（GCA）是一种以肉芽肿存在为特征的血管炎。它是成人系统性血管炎的主要形式，主要影响年龄≥50岁个体的较大动脉。GCA影响主要动脉，如主动脉及其分支，特别是颈外动脉的外周分支。体征和症状可分为颅内、颅外和全身表现。有头痛、颌部间歇性运动障碍和视力障碍的患者通常累及颈外动脉的颅外分支。除了是GCA的主要表现外，我们对这种变体的主要担忧是，如果未得到正确识别和处理，可能会导致不可逆的视力丧失。相反，GCA也可影响其他主要血管，如主动脉。在此，我们报告一例70岁白种女性颅部GCA患者，该患者三年前曾出现颞部头痛。患者接受泼尼松龙治疗成功，在甲氨蝶呤的辅助下逐渐减至非常低的剂量。最近，该患者出现持续两个月的干咳且炎症标志物升高。经过全面检查，确定没有感染证据，包括非典型感染，肺部也未发现异常。最终，通过18F-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET），该患者被诊断为大血管巨细胞动脉炎（LV-GCA）。病变累及主动脉、颈动脉和锁骨下动脉。该患者在接受高剂量口服泼尼松龙后，咳嗽明显改善，炎症标志物降低。本病例例证了LV-GCA的不寻常表现，并证实复发症状可能与最初表现不同。虽然干咳通常未被列为LV-GCA的症状，但在某些患者中可能作为一种表现或唯一表现出现，特别是当炎症标志物持续升高且无肺部疾病时。
